Analysis Of The Effects Of Interventions On Salt And Hypertension-related Knowledge, Attitudes And Behaviors Among Primary And Middle School Students In Shandong Province

BackgroundSome research results at home and abroad preliminarily show that the improvement of salt-related knowledge,attitude and behavior in childhood hypertension is of positive significance for the prevention and control of hypertension.In order to reduce the salt intake of residents and prevent and control high blood pressure,the Shandong Provincial People's Government and the former Ministry of Health jointly launched a project to reduce salt and prevent hypertension.The project was implemented in Shandong Province from 2011 to 2016.The project carried out salt reduction intervention in two groups of adults and primary and secondary school students respectively.Objective1.To be aware of the effect of salt reduction intervention on primary and middle school students.2.To analyze the influencing factors in knowledge,belief and practice related to salt before and after intervention.3.To summarize the project implementation experience,and provide scientific basis for the future work.MethodDuring the project,Shandong Province put the salt reduction intervention into the school health education plan,and will carry out a series of salt reduction intervention activities such as health education classes,hand-written newspapers,composition competitions,etc.in all junior high schools and primary schools.In addition,focus on the fourth grade primary school students,to carry out winter vacation salt reduction family intervention.The project carried out two cross-sectional surveys before and after the intervention to evaluate the intervention effect.In both surveys,primary and secondary school students aged 6-17 were selected by the method of stratified cluster random sampling.The survey collected information through questionnaires and physical measurements.The contents of the questionnaire mainly include the basic situation of the survey subjects,dietary habits and knowledge,attitude and practice related to salt and hypertension.Physical measurement mainly includes height,weight,blood pressure and other indicators.The survey adopted electronic questionnaire,which can input data directly into PAD at the same time of the survey,reducing errors caused by secondary entry.The verification and clean-up of data is carried out by the data management team.The data analysis was performed by SPSS 17.0 statistical software.After the weight adjustment,the statistical description of the classified data was performed by frequency and weighted composition ratio,and the chi-square test was used to compare the rates.Results1.Hypertension and salt related knowledgeIn the baseline survey,the awareness rates of four knowledge indicators,namely"adult hypertension diagnostic standard”,"adult salt intake standard","eating less salt can help lower blood pressure",and"low sodium salt",were respectively 18.2%,30.0%,45.6%and 17.8%.There were differences among the four knowledge indicators in all age groups(P<0.05).At the end of the survey,the awareness rates of the four knowledge indicators were 47.0%,73.5%,76.7%and 59.2%respectively,all higher than that in 2011(P<0.05).Among the students who knew low sodium salt,the awareness rate of low sodium salt helping to reduce blood pressure was 26.5%,which was 81.8%in 2016,higher than 2011(P<0.05).2.Salt related attitudeAt the baseline survey,the acceptance rate of labeled sodium salt in processed foods was 78.9%,which increased with age(P<0.05).At the end of the survey,the acceptance rate was 86.8%,which was not different from the baseline(P>0.05).The approval rate of low salt diet was 49.3%in baseline survey,higher in girls than in boys(P<0.05),and increased in normal BMI,overweight and obese students(P<0.05).At the end of the survey,the approval rate was 69.3%,higher in girls than in boys(P<0.05).There were significant differences among different age groups(P<0.05).The approval rate in 2016 was higher than that in 2011(P<0.05).3.Salt related behaviorIn the baseline survey,the behavioral formation rates of the three behavioral indicators,namely"concern about the sodium content of processed food","active choice of low-salt food”and"family use of quantitative salt spoon",were 28.1%,38.8%and 17.4%,respectively.At the end of the survey,the formation rates of the three behaviors were 58.6%,61.4%and 55.1%respectively,all higher than that in 2011(P<0.05).The rates of behavior fonnation of 9-14 years old students were higher in 2016 than in 2011(P<0.05).The rates of behavior formation of normal,overweight and obese students with BMI was also higher in 2016 than in 2011(P<0.05).In the households using quantitative salt spoons,the correct use rate of quantitative salt spoons was 65.2%in 2011,86.8%in 2016,and higher than 2011 in 2016(P<0.05).All gender and BMI students were higher in 2016 than in 2011(P<0.05).4.5.Dietary habits5.1 Dietary structureIn the baseline survey,the proportion of meat-based diet was 5.2%.At the end of the survey,the proportion of meat-based diet was 6.0%.Both surveys showed that boys were higher than girls(P<0.05),and there were differences among different age groups(P<0.05).The proportion of meat-based diet in 2016 was higher than that in 2011(P<0.05).Boys in 2016 were higher than in 2011,but girls in 2016 were lower than in 2011(P<0.05).5.2 Salt and oil tasteIn the baseline survey,the salt preference rate was 13.9%,which was higher in boys than in girls(P<0.05).At the end of the survey,the salt preference rate was 10.7%,which was lower than that in 2011(P<0.05).In the baseline survey,the proportion of greasy taste was 5.7%.At the end of the survey,it was 6.2%,which was no difference from baseline(P>0.05).5.3 Effect of low salt on tasteThe acceptance rate of low salt taste was 74.9%in baseline survey,and there were differences among different age groups(P<0.05).The acceptance rate was 82.4%at the end of the survey,which was higher than that in 2011(P<0.05).Conclusion1.The implementation of the Shandong provincial salt reduction project has improved the knowledge,attitudes and behaviors of salt among local primary and middle school students,and the knowledge improvement effect is most obvious.2.Interventions had a better effect on salt-related knowledge and attitudes among girls,but there is no difference in the development of healthy behaviors compared with boys.3.The intervention effect of students of different ages is different.Among them,students aged 9-14 had the best effect,and their knowledge,belief and practice level were improved.The intervention effect of students aged 6-8 is the weakest,and only a few of them have improved their knowledge,belief and behavior.The knowledge level of students aged 15-17 has improved to some extent,but their attitudes and behaviors have not changed significantly.4.The salt preference rate of primary and secondary school students in Shandong province decreased after the intervention.